台灣地區肌萎縮性脊髓側索硬化症病患之流行病學、死因及死亡場所探討：利用全民健保資料庫之分析

Epidemiology, underlying causes and place of death in patients with amyotrophic lateral sclerosis in Taiwan: a population-based National Health Insurance study

張博翔(Bo Hsiung Chang)

指導教授 ： 李子奇

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00014

摘要

研究背景
全球已經有一些研究探討肌萎縮性脊髓側索硬化症(ALS)病患的死因。本研究調查2003-2008年台灣地區ALS病患的死亡率、死因及死亡場所。

研究方法
本研究利用國家衛生研究院所提供的一個以全國族群為基礎的資料來做分析。共有751個被診斷出ALS且追蹤其死因資料至2008年的病患被納入研究。研究依據死因別、性別及年齡別 (0-44, 45-64, 65+) 來計算粗死亡率 (100人年) 及標準化死亡率 (SMRs)。

研究結果
在751個ALS病患中，有297個 (39.55%) 病患在研究期間內死亡；年齡、性別標準化後，台灣地區ALS病患死亡的風險是一般居民的13倍 (95%CI, 10.6-15.6)。男性的粗死亡率與女性是相似的，分別為17.99% (100人年) 及16.84% (100人年)。但女性的SMR卻高於男性，分別為21.5 (95%CI, 15.3-29.4) 及9.5 (95%CI, 7.4-12.0)。在死因別的部分，感染及呼吸系統疾病、心血管疾病的及自殺的SMR皆高於一般居民，分別為49.6 (95%CI, 35.9-66.8)、11.7 (95%CI, 7.2-17.8) 及6.9 (95%CI, 1.9-17.6)。在297個ALS死亡病患中，有154個死於醫療機構，134個死於非醫療機構。

討論
2003-2008年台灣ALS病患中大多數的病患死於感染及呼吸系統疾病、心血管疾病及自殺。台灣ALS病患診斷初期的自殺防治是非常急迫的。

關鍵字

肌萎縮性脊髓側索硬化症 ； 死因 ； 神經系統疾病 ； 感染及呼吸系統疾病

並列摘要

Background
Few studies in the world have assessed the cause of death of amyotrophic lateral sclerosis patients. We investigated the mortality and underlying causes of death in patients with amyotrophic lateral sclerosis in Taiwan, 2003-2008.

Methods
A population-based data from National Health Insurance in Taiwan between 2003 and 2008 was utilized. A total number of 751 individuals with a primary diagnosis of ALS were included and followed until 2008 on a national mortality database. Crude mortality rate (per 100 person-year) and standardized mortality ratios (SMRs) were calculated by underlying cause of death, sex and age-group (0-44, 45-64, 65+).

Results
Of the 751 ALS individuals, a total of 297 (39.55%) died during the follow-up period ; representing a 13-fold (95% CI at 10.6-15.6) age- and gender-standardized increase in general population in Taiwan. Male mortality rate 17.99% (person-year) was similar with female 16.84% (person-year). But female SMR 21.5 (95% CI at 15.3-29.4) was significant higher than male SMR 9.5 (95% CI at 7.4-12.0). Cause of death on ALS was higher than the general population in infectious and respiratory diseases (SMR=49.6, 95% CI at 35.9-66.8), Cardiovascular diseases (SMR=11.7, 95% CI at 7.2-17.8) and suicide (SMR=6.9, 95% CI at 1.9-17.6). Of the 297 ALS individuals who died during the follow-up period, 154 individuals died in a medical facility and 134 individuals died outside a medical facility.

Conclusions
ALS patients predominate died cause by infectious and respiratory diseases, Cardiovascular diseases and suicide in Taiwan, 2003-2008. Suicide prevention was urgency in the early phase of ALS diagnosis in Taiwan.

並列關鍵字

amyotrophic lateral sclerosis ； cause of death ； nervous system

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